Rannem T, Ladefoged K, Hylander E, Hegnhøj J, Staun M
Dept. of Medical Gastroenterology CA, Rigshospitalet, Copenhagen, Denmark.
Scand J Gastroenterol. 1998 Oct;33(10):1057-61. doi: 10.1080/003655298750026750.
Patients with intestinal disease are at risk of developing selenium deficiency due to impaired intestinal absorption. The aim of the present study was to evaluate selenium status and to identify predictive factors of selenium depletion in patients with gastrointestinal disease.
The concentration of selenium and the activity of glutathione peroxidase in plasma and erythrocytes were measured by fluorometry and by spectrophotometry. Eighty-six patients with Crohn's disease, 40 patients with ulcerative colitis, and 39 patients with various other gastrointestinal diseases were studied. Twenty-seven patients (16%) received home parenteral nutrition. Stool mass, faecal fat, and vitamin B12 absorption were analysed in 100 patients.
The plasma selenium concentration was decreased in 85% of the patients receiving supplementary parenteral nutrition and in 20% of the patients receiving oral nutrition, among them in 26% of the patients with Crohn's disease. Almost all patients with ulcerative colitis had normal selenium levels. A statistically significant correlation was found between plasma selenium and vitamin B12 absorption, stool mass, faecal fat excretion, body mass index, P-albumin, P-zinc, and the length of the remaining small bowel. Stepwise regression analyses showed that the strongest predictors of selenium deficiency were stool mass, vitamin B12 absorption, and the length of the small-bowel resection.
Selenium deficiency is common in patients with severe gastrointestinal disorders. The deficiency is mainly related to malabsorption, and a low selenium level was almost invariably present in patients who needed parenteral supplementation due to gut failure.
肠道疾病患者由于肠道吸收受损而有发生硒缺乏的风险。本研究的目的是评估胃肠道疾病患者的硒状态，并确定硒缺乏的预测因素。
采用荧光法和分光光度法测定血浆和红细胞中硒的浓度以及谷胱甘肽过氧化物酶的活性。对86例克罗恩病患者、40例溃疡性结肠炎患者和39例其他各种胃肠道疾病患者进行了研究。27例患者（16%）接受家庭肠外营养。对100例患者的粪便量、粪便脂肪和维生素B12吸收情况进行了分析。
接受补充肠外营养的患者中有85%血浆硒浓度降低，接受口服营养的患者中有20%血浆硒浓度降低，其中克罗恩病患者中有26%血浆硒浓度降低。几乎所有溃疡性结肠炎患者的硒水平正常。发现血浆硒与维生素B12吸收、粪便量、粪便脂肪排泄、体重指数、血清白蛋白、血清锌以及剩余小肠长度之间存在统计学显著相关性。逐步回归分析表明，硒缺乏的最强预测因素是粪便量、维生素B12吸收和小肠切除长度。
严重胃肠道疾病患者中硒缺乏很常见。这种缺乏主要与吸收不良有关，因肠道衰竭需要肠外补充的患者几乎都存在低硒水平。
